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High incidence of vitreomacular traction in recurrent choroidal neovascularisation after repeated photodynamic therapy
  1. J C Schmidt,
  2. S Mennel,
  3. S Hörle,
  4. C H Meyer
  1. Department of Ophthalmology, Philipps-University Marburg, Marburg, Germany
  1. Correspondence to: C H Meyer Department of Ophthalmology, Philipps-University Marburg, Robert-Koch-Strasse 4, 35037 Marburg, Germany; meyer_eye{at}yahoo.com

Abstract

Background: The causes of recurrent choroidal neovascularisation (CNV) after photodynamic therapy (PDT) remain controversial. Subretinal surgery was carried out after unsuccessful PDT.

Aims: To determine intraoperatively the status of the posterior vitreous interface.

Design: Interventional case series.

Methods: Conventional three-port vitrectomy was carried out in 10 eyes with CNV that had undergone 1–4 PDT sessions. The vitreous cutter was held close to the edge of the optic nerve to evaluate the status of the posterior vitreous.

Results: Lesion size showed an increase from 1.5 (standard deviation (SD) 0.53) to 2.3 (SD 0.83) macular photocoagulation study disc diameters, between the first and the last PDT. Intraoperative findings during vitrectomy showed little liquefaction of the vitreous gel and an incomplete posterior-vitreous detachment, with remarkably firm attachments at the macula in all cases (10/10).

Conclusion: We determined an abnormally high incidence of vitreous attachments in eyes with recurrent CNV. Vitreomacular attachments may trigger the progression or recurrence of CNV.

  • AMD, age-related macular degeneration
  • CNV, choroidal neovascularisation
  • PDT, photodynamic therapy
  • PVD, posterior-vitreous detachment
  • VEGF, vascular endothelial growth factor
  • VMT, vitreomacular traction

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Footnotes

  • Published Online First 19 July 2006

  • This study was supported by the Fehr Foundation, Marburg, and was presented in part at the Jules Gonin Meeting 2006, Cape Town.

  • Competing interests: None.

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